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Individual

DR. KENNETH R SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4913 W RENO AVE, OKLAHOMA CITY, OK 73127-6339
(405) 948-4900
Mailing address
630 TIMBER LN, EDMOND, OK 73034-4629
(405) 359-9213

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18149
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1118149
OK
Enumeration date
07/13/2006
Last updated
07/25/2013
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